Lu Yining, Agarwalla Avinesh, Lavoie-Gagne Ophelie, Patel Bhavik H, Beletsky Alexander, Nwachukwu Benedict U, Verma Nikhil N, Cole Brian J, Forsythe Brian
Department of Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, New York, USA.
Orthop J Sports Med. 2022 Mar 8;10(3):23259671221070857. doi: 10.1177/23259671221070857. eCollection 2022 Mar.
Clinically significant outcomes (CSOs) connect patient-reported outcome measures data to patient-perceived benefit. Although investigators have established threshold values for various CSOs, the timeline to achieve these outcomes after isolated biceps tenodesis (BT) has yet to be defined.
To define the time-dependent nature of minimal clinically important difference (MCID), substantial clinical benefit (SCB), and Patient Acceptable Symptom State (PASS) achievement after isolated BT.
Case series; Level of evidence, 4.
The American Shoulder and Elbow Surgeons score (ASES), the Single Assessment Numeric Evaluation, and the Constant-Murley score (CMS) were administered preoperatively and at 6 and 12 months postoperatively to patients undergoing isolated BT between 2014 and 2018 at our institution. Cumulative probabilities for achieving MCID, SCB, and PASS were calculated using Kaplan-Meier survival analysis. Weibull parametric regression evaluated the hazard ratios (HRs) of achieving earlier MCID, SCB, and PASS.
Overall cohort (N = 190) achievement rates ranged between 77.8% and 83.2% for MCID, between 42.2% and 80.2% for SCB, and between 59.7% and 62.9% for PASS. Median achievement time was 5.3 to 6.1 months for MCID, 5.9 to 6.4 months for SCB, and 6.07 to 6.1 months for PASS. Multivariate Weibull parametric regression identified older age, male sex, higher body mass index, preoperative thyroid disease, smoking history, and higher preoperative CMS as predictors of delayed CSO achievement (HR, 1.01-6.41), whereas normal tendon on arthroscopy, defined as absence of tenosynovitis or tendon tear on arthroscopy, predicted earlier CSO achievement (HR, 0.19-0.46). Location of tenodesis and worker compensation status did not significantly predict the time to achieve CSOs on multivariate analysis.
After isolated BT, patients can expect to attain CSO by 13 months postoperatively, with most patients achieving this between 5 and 8 months. Patients tend to take longer to achieve PASS than MCID and SCB.
具有临床意义的结果（CSOs）将患者报告的结局指标数据与患者感知的获益联系起来。尽管研究人员已经确定了各种CSOs的阈值，但孤立性肱二头肌肌腱固定术（BT）后达到这些结果的时间线尚未明确。
确定孤立性BT后最小临床重要差异（MCID）、显著临床获益（SCB）和患者可接受症状状态（PASS）实现的时间依赖性。
病例系列；证据等级，4级。
对2014年至2018年在本机构接受孤立性BT的患者在术前、术后6个月和12个月进行美国肩肘外科医师评分（ASES）、单项评估数值评定法和Constant-Murley评分（CMS）。使用Kaplan-Meier生存分析计算实现MCID、SCB和PASS的累积概率。Weibull参数回归评估实现更早的MCID、SCB和PASS的风险比（HRs）。
总体队列（N = 190）中，MCID的实现率在77.8%至83.2%之间，SCB的实现率在42.2%至80.2%之间，PASS的实现率在59.7%至62.9%之间。MCID的中位实现时间为5.3至6.1个月，SCB为5.9至6.4个月，PASS为6.07至6.1个月。多变量Weibull参数回归确定年龄较大、男性、较高的体重指数、术前甲状腺疾病、吸烟史和较高的术前CMS是CSO实现延迟的预测因素（HR，1.01 - 6.41），而关节镜检查时肌腱正常（定义为关节镜检查时无腱鞘炎或肌腱撕裂）则预测CSO实现较早（HR，0.19 - 0.46）。肌腱固定的位置和工伤赔偿状态在多变量分析中并未显著预测达到CSOs的时间。
孤立性BT后，患者可预期在术后13个月内达到CSO，大多数患者在5至8个月内实现。患者达到PASS的时间往往比MCID和SCB更长。
